Open AccessIntracardiac echocardiography for verification for left atrial appendage thrombus presence detected by transesophageal echocardiography: the ActionICE II study
Author(s) -
Baran Jakub,
Zaborska Beata,
Piotrowski Roman,
SikoraFrąc Malgorzata,
PilichowskaPaszkiet Ewa,
Kułakowski Piotr
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22675
Subject(s) - medicine , thrombus , cardiology , atrial fibrillation , stroke (engine) , cardioversion , ablation of atrial fibrillation , embolism , intracardiac injection , radiology , catheter ablation , engineering , mechanical engineering
Background Transesophageal echocardiography ( TEE ) remains the gold standard for exclusion of left atrial appendage ( LAA ) thrombus in patients scheduled for direct electrical cardioversion ( DEC ) or atrial fibrillation ( AF ) ablation. Recently, intracardiac echocardiography ( ICE ) of the pulmonary artery ( PA ) has been shown to provide excellent LAA images and to be useful in verification of equivocal TEE findings. Hypothesis ICE of the PA may have a role in detecting false‐positive TEE results. Methods Twenty‐one patients (12 male, age 65 ± 8 years, CHADS2VASC2 score [congestive heart failure, hypertension, age ≥ 75, age 65‐74, diabetes mellitus, stroke/TIA/thrombo‐embolism, vascular disease, sex female] = 2.2; HAS‐BLED score [hypertension, abnormal renal and liver function, stroke, bleeding, labile International Normalized Ratio, elderly, drugs or alcohol] = 1.1), in whom a thrombus in the LAA was detected during TEE before DEC or AF ablation, underwent ICE of the PA . Results On TEE , in 7 (33%) patients, the LAA thrombus was described as “solid” and in the remaining 14 (67%) as “soft.” Disagreement between the TEE and ICE (thrombus in TEE and no thrombus in ICE ) was found in 9 (43%) patients. In the solid thrombus group, ICE confirmed thrombi existence in 6 and excluded thrombi in 1 patient. In the soft thrombus group, ICE confirmed thrombi in 6 patients and excluded thrombi in the remaining 8 patients. Of the demographic and clinical variables, only the longstanding persistent type of AF was significantly associated with the presence of an LAA thrombus detected both by TEE and ICE . Conclusions With TEE , a false positive of an LAA thrombus may be indicated, especially when a thrombus is described as soft rather than solid. Our study suggests that ICE may be a valuable option for verification of a TEE ‐based diagnosis of a thrombus.